Deaths spiral out of control in Aids crisis
South Africa suffers 59pc mortality jump in six years
Peter Beaumont, foreign affairs editor
Sunday February 20, 2005
Observer
http://observer.guardian.co.uk/international/story/0,6903,1418510,00.html
South Africa's mortality rate has jumped by 59 per cent in six years, fuelled by the HIV/Aids epidemic, according to new figures published this weekend by the country's central statistical office.
The report, which has been mired in political controversy even before its publication, says women have represented the biggest increase, while more adults of both sexes now are dying than in 1997.
In 1997 149 men aged between 25 and 29 were dying for every 100 deaths among women. In 2003 that figure had leapt to 77 male deaths for every 100 female deaths.
The figures are based on a survey by the government agency Statistics South Africa which analysed the cause of death of around three million South Africans notified to the Department of Home Affairs between 1997 and 2003.
The poll is a potential bombshell in a country where health professionals and the government have been locked in a bitter struggle over the real scale of the HIV/Aids epidemic.
Although tuberculosis, influenza and pneumonia, and cerebrovascular diseases were listed as the leading causes of death, the Statistician-General Pali Lehohla, said on Friday that the data had 'provided indirect evidence that the HIV/Aids epidemic in South Africa is raising the mortality levels of prime-aged adults, in that associated diseases are on the increase'.
The release of the mortality figures was already controversial even before their publication with claims that the statistics were being suppressed by President Thabo Mbeki, who has long attempted to play down the scale of the Aids crisis and who criticised the same agency in 2001 for the claim that 40 per cent of South Africans were HIV positive.
The report concluded that the average number of deaths rose to 1,370 a day in 2002 from 870 in 1997, an increase that could not be explained by the 10 per cent increase in population during the same period. Dr Steve Andrews, an HIV clinician and consultant in Cape Town, told the New York Times he believed the figures suggested that far from the report having been made more politically palatable, 'we should not be seeing this aggressive move in death rates - not at all'.
The new figures have emerged amid an escalating row over the South African government's handling of HIV/Aids which forced the country's Health Minister, Manto Tshabalala-Msimang, to issue a statement maintaining that South Africa's Aids policy is among the world's best.
'Very few plans are as comprehensive as ours, bringing together elements of prevention, nutrition and a variety of different treatments,' Tshabalala-Msimang claimed. But the government target of having 53,000 people at 113 state-accredited health centres on free antiretroviral therapy by March 2005 is still falling short. Recent figures from the Aids lobby group, Treatment Action Campaign, indicate that only 29,332 people were accessing the drugs.
The escalating Aids crisis - and claims that the government is doing too little to stem the spread of the disease - has seen increasing public discontent.
Last week Aids activists once again marched to parliament to demand a ten-fold increase in the number of people being treated on retroviral drugs by 2006.
Receiving the petition South Africa's presidential head of communications, Murphy Morobe, said that he personally had lost six family members to HIV/Aids over the past three years.
Morobe's remarks are in contrast to President Mbeki's statement in 2003 that he 'did not personally know anyone who had died from Aids'.
The latest official figures will put new pressure on the president, following hard on research published earlier this year in the journal Aids whose authors estimated that more than 112,000 people died of HIV-related illnesses in 2000-01 alone - nearly three times the figure given by South Africa's department of home affairs.
The country has been accused repeatedly of deliberately underestimating the Aids death toll - and therefore failing to allocate sufficient resources.
A 2002 survey by Statistics South Africa showed that only 8.7 per cent of deaths in the country were caused by HIV/Aids.
But medical researchers and Aids charities insisted at the time that it had massively downplayed the scale of the pandemic.
Guardian Unlimited � Guardian Newspapers Limited 2005
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AIDS deaths soaring in South Africa
By Michael Wines The New York Times
Saturday, February 19, 2005
http://www.iht.com/articles/2005/02/18/news/africa.html
JOHANNESBURG In an implicit but devastating account of the havoc AIDS is wreaking here, the South African government reported Friday that annual deaths increased 57 percent from 1997 to 2003, with common AIDS-related diseases like tuberculosis and pneumonia fueling much of the rise.
The report states that 499,000 of South Africa's roughly 44 million people died in 2002 compared with 318,000 in 1997. Overall, at least 5 million citizens are HIV positive, the most of any country on earth.
The increase in mortality spanned all age groups, but was most pronounced among those between ages 15 and 49,
where
deaths more than doubled.
Working-age adults are more sexually active than the rest of the population and the opportunity for transmitting HIV, the virus that causes AIDS, is greatest among members of this group.
The report, by the government agency Statistics South Africa, was dogged by controversy even before its release, which came more than a month after the originally scheduled date. Critics charged - and the agency denied - that the delay was due to political pressure from President Thabo Mbeki's government, which has been accused of playing down the dimensions of the AIDS crisis here.
Mbeki's office sharply rebuked the agency in 2001 after it reported that 4 in 10 deaths among working-age adults were probably due to AIDS, saying that statisticians could not prove their conclusion.
The statistics agency has denied that the report Friday was politically influenced.
The report notes that both the total number of deaths and their cause
s are
undoubtedly inaccurate, because death reporting is not consistent in rural areas and medical expertise is uneven across the country.
Diagnosing AIDS as a cause of death can require advanced medical knowledge and equipment.
Moreover, an unknown number of AIDS deaths goes unreported because South African insurance policies frequently do not cover AIDS-related deaths.
Nevertheless, the agency reported that the new figures "provide indirect evidence that HIV may be contributing to the increase in the level of mortality for prime-aged adults, given the increasing number of deaths due to associated diseases."
Dr. Steve Andrews, an HIV clinician and consultant in Cape Town, said that the sobering figures in the report suggested that it had not been politically varnished.
Given the improvement in medical care and living standards in South Africa, "we should not be seeing this aggressive move in death rates - not at all," he said.
The repor
t
concluded that the average number of deaths in South Africa rose from 870 per day in 1997 to 1,370 in 2002, an increase that could not be explained by the 10 percent increase in the population during the same period.
The reported causes of death point to AIDS as the factor underlying much of the increase in mortality.
Deaths from tuberculosis, influenza and pneumonia - all primary causes of AIDS-related deaths - more than doubled from 1997 to 2001, while deaths from other AIDS-related diseases like gastrointestinal infections rose about 25 percent.
Deaths from some ailments unrelated to AIDS, like hypertension and cerebrovascular problems, also rose, but at a lower rate.
General heart disease, once by far the biggest killer of South Africans, fell during the period and was well behind tuberculosis and influenza in 2001.
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